October 15, 2009

Objectives: We investigated the possible relationship between being shot in an assault and possession of a gun at the time.

Methods: We enrolled 677 case participants that had been shot in an assault and 684 population-based control participants within Philadelphia, PA, from 2003 to 2006. We adjusted odds ratios for confounding variables.

Results: After adjustment, individuals in possession of a gun were 4.46 (P<.05) times more likely to be shot in an assault than those not in possession. Among gun assaults where the victim had at least some chance to resist, this adjusted odds ratio increased to 5.45 (P<.05).

Conclusions: On average, guns did not protect those who possessed them from being shot in an assault. Although successful defensive gun uses occur each year, the probability of success may be low for civilian gun users in urban areas. Such users should reconsider their possession of guns or, at least, understand that regular possession necessitates careful safety countermeasures.

Abstract:This paper examines the impact on agricultural development from the introduction of barbed wire fencing to the American Plains in the late 19th century. Without a fence, farmers risked uncompensated damage by others' livestock. From 1880 to 1900, the introduction and near universal adoption of barbed wire greatly reduced the cost of fences, relative to predominant wooden fences, most in counties with the least woodland. Over that period, counties with the least woodland experienced substantial relative increases in settlement, land improvement, land values, and the productivity and production share of crops most in need of protection. This increase in agricultural development appears partly to reflect farmers' increased ability to protect their land from encroachment. States' inability to protect this full bundle of property rights on the frontier, beyond providing formal land titles, might have otherwise restricted agricultural development.

Abstract:Using detailed data on traffic speeds for 12 Los Angeles freeway routes from 2001 to 2006, we investigate aggregate behavioral response to gasoline prices. If traffic is free flowing, drivers should slow to more fuel-efficient speeds as the price of gasoline rises. However, we find little evidence that drivers respond to increased fuel costs by slowing down. When congestion constrains traffic flow, freeway speeds should rise with gasoline price, and we find a $1.00 increase in price raises average freeway speeds by approximately 7% during rush-hour periods. Finally, we introduce a novel method to calculate the short-run vehicle miles traveled demand elasticity during rush hour.

Abstract:With the escalation of terrorism worldwide in recent years, situations arise in which the perpetration of violence and the defense of human rights come into conflict, creating serious ethical problems. The Geneva Convention provides guidelines for the medical treatment of enemy wounded and sick, as well as prisoners of war. However, there are no comparable provisions for the treatment of terrorists, who can be termed unlawful combatants or unprivileged belligerents. Two cases of severely injured terrorists are presented here to illustrate the dilemmas facing the medical staff that treated them. It is suggested that international legal and bioethical guidelines are required to define the role of the physician and auxiliary medical staff vis a vis injured terrorists. There are extreme situations where the perpetration of violence and the defense of human rights come into conflict, leading to serious ethical and psychological discord. Terrorists, using violence to create fear in order to further their political objectives, might require life-saving medical care if injured during the course of their terror activities.

Abstract:We develop a dynamic model in which Operation Iraqi Freedom (OIF) servicemembers incur a random amount of combat stress during each month of deployment, develop posttraumatic stress disorder (PTSD) if their cumulative stress exceeds a servicemember-specific threshold, and then develop symptoms of PTSD after an additional time lag. Using Department of Defense deployment data and Mental Health Advisory Team PTSD survey data to calibrate the model, we predict that-because of the long time lags and the fact that some surveyed servicemembers experience additional combat after being surveyed-the fraction of Army soldiers and Marines who eventually suffer from PTSD will be approximately twice as large as in the raw survey data. We cannot put a confidence interval around this estimate, but there is considerable uncertainty (perhaps ±30%). The estimated PTSD rate translates into {approx}300,000 PTSD cases among all Army soldiers and Marines in OIF, with {approx}20,000 new cases each year the war is prolonged. The heterogeneity of threshold levels among servicemembers suggests that although multiple deployments raise an individual's risk of PTSD, in aggregate, multiple deployments lower the total number of PTSD cases by {approx}30% relative to a hypothetical case in which the war was fought with many more servicemembers (i.e., a draft) deploying only once. The time lag dynamics suggest that, in aggregate, reserve servicemembers show symptoms {approx}1-2 years before active servicemembers and predict that >75% of OIF servicemembers who self-reported symptoms during their second deployment were exposed to the PTSD-generating stress during their first deployment.

Abstract:One of the principal vehicles for informing tobacco consumers about the risks of smoking is the warning message on each cigarette package. Based on terror management theory, the present study investigates the impact of mortality-salient warnings on cigarette packages compared to warnings with no mortality threat. Results suggest that to the degree that smoking is a source of self-esteem, later attitudes towards smoking become more positive if the warning message is mortality-salient. On the contrary, if the warning is terrifying but not mortality-salient and relates to the source of self-esteem, smoking attitudes become more negative with higher smoking-based self-esteem. Thus, mortality-salient warnings may increase the tendency to favor smoking under certain circumstances. This fatal ironic effect highlights the importance of a risk communication that matches the self-esteem contingencies of the recipients, and it has urgent implications for health care policy.

Background: This paper reports on qualitative research on smoking in contexts associated with drinking among college students. Although a plethora of survey research has shown a positive association between smoking and alcohol use, little attention has been given to the utility functions of these co-occurring behaviors.

Methods: Data are drawn from semi-structured interviews with college freshmen at a large Mid-western university in the U.S. (n = 35). In addition, eleven focus groups with fraternity and sorority members were conducted (n = 70). Interviews and focus groups focused on a range of issues including current smoking behavior, reasons for smoking, and smoking and drinking.

Results: A review of qualitative responses reveals that smoking served multiple utility functions for this population including (1) facilitating social interaction across gender, (2) allowing one to structure time and space at a party, (3) enabling "party" smokers to smoke with fewer negative side effects, and (4) helping to calm one down when drunk.

Conclusions: Whereas smoking was stigmatized during the context of one's everyday life as a student, at parties while consuming alcohol, smoking was viewed as normative and socially acceptable. Preventive interventions are needed on college campus that target co-substance use and address widespread misperceptions about the harm of tobacco use and addiction.

Abstract:College students were identified who were unrealistically optimistic about the likelihood they would experience severe problems due to alcohol consumption. These individuals were then followed over a 2-year period to determine whether they were more likely to report experiencing a range of alcohol-related negative events. Unlike the majority of studies on unrealistic optimism, this study (a) assessed bias at the individual rather than group level and (b) used a prospective rather than cross-sectional design. Participants completed measures at four times, each separated by 4-6 months. Findings showed that unrealistic optimism at Time 1 was associated with a greater number of negative events at Times 2, 3, and 4. Similarly, unrealistic optimism at Time 2 was associated with more negative events at Times 3 and 4. In all cases, the relationships were significant when controlling for previous negative events, suggesting the effects of unrealistic optimism can mount over time.

Abstract:Individuals who abused alcohol at an early age show decision-making impairments. However, the question of whether maladaptive choice constitutes a predisposing factor to, or a consequence resulting from, alcohol exposure remains open. To examine whether a causal link exists between voluntary alcohol consumption during adolescence and adult decision making the present studies used a rodent model. High levels of voluntary alcohol intake were promoted by providing adolescent rats with access to alcohol in a palatable gel matrix under nondeprivation conditions. A probability-discounting instrumental response task offered a choice between large but uncertain rewards and small but certain rewards to assess risk-based choice in adulthood either 3 weeks or 3 months following alcohol exposure. While control animals' performance on this task closely conformed to a predictive model of risk-neutral value matching, rats that consumed high levels of alcohol during adolescence violated this model, demonstrating greater risk preference. Evidence of significant risk bias was still present when choice was assessed 3 months following discontinuation of alcohol access. These findings provide evidence that adolescent alcohol exposure may lead to altered decision making during adulthood and this model offers a promising approach to the investigation of the neurobiological underpinnings of this link.

Abstract:The minimum legal drinking age (MLDA) is widely believed to save lives by reducing traffic fatalities among underage drivers. Further, the Federal Uniform Drinking Age Act, which pressured all states to adopt an MLDA of 21, is regarded as having contributed enormously to this life-saving effect. This article challenges both claims. State-level panel data for the past 30 yr show that any nationwide impact of the MLDA is driven by states that increased their MLDA prior to any inducement from the federal government. Even in early-adopting states, the impact of the MLDA did not persist much past the year of adoption. The MLDA appears to have only a minor impact on teen drinking.

Abstract:This paper uses variation in traffic safety laws and obesity rates to identify substitution patterns between living and cadaveric kidney donors. Using panel data from 1988-2008, we find that a 1% decrease in the supply of cadaveric donors per 100,000 increases the supply of living donors per 100,000 by .7%. With respect to traffic safety laws, a national adoption of partial helmet laws is estimated to decrease cadaveric donors by 6%, but leads to a 4.2% increase in the number of living donors, or a net effect of 1.8% decrease in the supply of kidney donations. The recent rise in obesity rates is estimated to increase living donor rates by roughly 18%. Lastly, we find evidence that increases in disposable income per capita is associated with an increase in the number of non-biological living donors within a state, but is not found to have an effect on biological donor rates.

Abstract:We investigate, using the 2002 US Health and Retirement Study, the factors influencing individuals' insecurity and expectations about terrorism, and study the effects these last have on households' portfolio choices and spending patterns. We find that females, the religiously devout, those equipped with a better memory, the less educated, and those living close to where the events of September 2001 took place worry a lot about their safety. In addition, fear of terrorism discourages households from investing in stocks, mostly through the high levels of insecurity felt by females. Insecurity due to terrorism also makes single men less likely to own a business. Finally, we find evidence of expenditure shifting away from recreational activities that can potentially leave one exposed to a terrorist attack and towards goods that might help one cope with the consequences of terrorism materially (increased use of car and spending on the house) or psychologically (spending on personal care products by females in couples).

Abstract:Much of prior work in the area of service operations management has assumed service rates to be exogenous to the level of load on the system. Using operational data from patient transport services and cardiothoracic surgery - two vastly different health-care delivery services - we show that the processing speed of service workers is influenced by the system load. We find that workers accelerate the service rate as load increases. In particular, a 10% increase in load reduces length of stay by two days for cardiothoracic surgery patients, whereas a 20% increase in the load for patient transporters reduces the transport time by 30 seconds. Moreover, we show that such acceleration may not be sustainable. Long periods of increased load (overwork) have the effect of decreasing the service rate. In cardiothoracic surgery, an increase in overwork by 1% increases length of stay by six hours. Consistent with prior studies in the medical literature, we also find that overwork is associated with a reduction in quality of care in cardiothoracic surgery - an increase in overwork by 10% is associated with an increase in likelihood of mortality by 2%. We also find that load is associated with an early discharge of patients, which is in turn correlated with a small increase in mortality rate.

Andrew Stickley & Per CarlsonScandinavian Journal of Public Health, August 2009, Pages 632-639

Background: Despite a high prevalence of smoking for decades, recent research has documented an increase in the rates of both male and female smoking in post-Soviet Russia. As yet, however, little research has taken place on smoking at the subnational level. The current study addresses this deficit by examining smoking in Moscow - the city that has been at the forefront of the entry into the Russian market of transnational tobacco corporations (TTCs) in the transition period.

Methods: Data were obtained from the Moscow Health Survey 2004 - a stratified random sample of 1190 people representative of Moscow's larger population. Information was obtained about subjects' smoking habits and age of smoking initiation.

Results: The prevalence of smoking was high among both men (55.5%) and women (26.9%), with significantly higher rates in the younger age groups. There was also a high prevalence of smoking initiation before age 15 years, especially in the youngest women (18-30 years). Logistic regression analysis showed that respondents' age, binge drinking, locus of control and economic situation were important determinants of smoking.

Conclusions: Although lifestyle factors seem to underpin the generally high levels of smoking, other things, such as its high prevalence in the younger generations and the factors associated with smoking (locus of control), nevertheless suggest that the TTCs may have played an important role in the spread of smoking in transitional Russia's changing social environment.